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Кардиоваскулярная терапия и профилактика

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Комбинированная липид-корригирующая терапия: выбор стратегии и тактики

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Аннотация

Достижение целевых уровней холестерина липопротеидов низкой плотности (ХС ЛНП) при использовании липид-корригирующей терапии — основное направление в снижении риска сердечно-сосудистых осложнений и смертности согласно российским и международным рекомендациям. Холестерин липопротеидов высокой плотности и триглицериды рассматриваются как вторичные цели при назначении гиполипидемических препаратов. Монотерапия статинами даже в высоких дозах и назначение других холестерин-снижающих средств позволяют достичь целевого уровня ХС ЛНП лишь в 30-50 % случаев. Анализ ряда опубликованных исследований показал, что для достижения целевых уровней ХС ЛНП более эффективно добавлять к статину дополнительное липид-корригирующее средство или назначать фиксированную комбинированную холестерин-снижающую терапию. Максимальное снижение ХС ЛНП обеспечивается при дополнительном назначении к статину эзетимиба или при использовании фиксированной комбинации — симвастатин 20 мг и эзетимиб 10 мг в одной таблетке. В зависимости от клинической ситуации рассмотрены особенности назначения комбинированной липид-корригирующей терапии согласно существующим рекомендациям. Для достижения высокой приверженности больных холестерин-снижающим препаратам необходимо с пациентами обсуждать и рассчитывать их сердечно-сосудистый риск.

Об авторе

Н. А. Козиолова
ГОУ ВПО “Пермская государственная медицинская академия имени академика Е.А. Вагнера Росздрава”. Пермь
Россия
зав. кафедрой внутренних болезней педиатрического и стоматологического факультетов, главный кардиолог МЗ Пермского края


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Для цитирования:


Козиолова Н.А. Комбинированная липид-корригирующая терапия: выбор стратегии и тактики. Кардиоваскулярная терапия и профилактика. 2010;9(4):107-115.

For citation:


Koziolova N.A. Combined lipid-lowering therapy: choosing strategy and tactics. Cardiovascular Therapy and Prevention. 2010;9(4):107-115. (In Russ.)

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